Organisation submitting example
Local authority/local area:
We work closely with six London-based LAs (Islington, Camden, Harrow, Hammersmith and Fulham Waltham Forest and Wandsworth) as well as offering spot purchase placements to other LAs in London. We are supporting Cambridgeshire and Sandwell to develop their own concurrent planning projects.
The context and rationale
Concurrent planning is an approach to permanence planning in fostering and adoption, focused on very vulnerable children aged 0-24 months. It places babies who are the subject of care proceedings with carers who are dually approved as foster carers and adopters, so that whatever the outcome of proceedings (adoption or rehabilitation) they do not suffer unnecessary moves and broken attachments.
Concurrent planning (CP) supports early permanence planning in fostering and adoption. It was developed in the US in the 1980s and brought to the UK in 1998, when the first CP scheme, the Goodman Project, was launched by the Manchester Adoption Agency. Coram set up its concurrent planning project in 1999, and this is now the only dedicated team nationally.
Concurrent planning is decided by the local authority as the child’s care plan and agreed by the court. The aim of concurrent planning is to support either the child’s return to their birth family or their permanent placement with an adoptive family. These aims are worked on concurrently, instead of sequentially (as is more usual), as the name implies.
It is designed for very vulnerable children aged 0–24 months where there is a high level of probability (greater than 80%) that return to their birth family or extended family will not be possible given the previous history, but a further period of assessment is thought necessary before the courts can come to a final decision. The parents may have already had a child taken into care, or may have severe mental health problems or substance misuse problems, or the mother may have a partner who has a history of offences against children.
Concurrent planning works actively to enable the birth family to take up this last chance of demonstrating that they can care for their baby safely. Its aim is to achieve the return of the child, where possible, and to avoid the considerable delays and frequent change of foster placements commonly experienced by these vulnerable, very young children before permanent placement can be made, whether this is the child’s return to the birth family or adoption. Research shows that the longer the delay and the greater the number of foster placements, the greater the potential for damage to a child’s mental health and development, and the less likely it is that they can be placed permanently and successfully with an adoptive family. Concurrent planning lays the foundations for greatly improved health and emotional wellbeing throughout the child’s life by giving more stability during the vital early years of development.
The Coram concurrent planning project recruits foster carers whom the project also approves as adopters. They must be willing to foster a baby in the first instance, and to support the child’s return to the birth parent, with the possibility that the fostering arrangement will lead to adoption, depending on the outcome of the court proceedings.
The Coram concurrent planning project offers:
• a stable placement with foster carers who are also approved as adopters
• expert supervised contact in a dedicated contact room
• a parenting assessment for the Court if requested
• assessment of relatives who are possible carers for the child if requested
• support for parents to make the required changes in their lives
• support for parents if the child is returned to their care
• continued work with parents if adoption is the outcome
• facilitation and support of post-adoption contact (direct and indirect)
• post-adoption support for children and adoptive parents.
Concurrent planning is widely hailed as an excellent approach, for example in Demos’s report In Loco Parentis, and it is actively promoted by the government. Guidance was clarified in June 2012 (http://www.education.gov.uk/childrenandyoungpeople/families/adoption/b0072314/guidance/ch2/concurrent) and new ‘Proposals for earlier placement of children with their potential adopters’ were published on the 6 July 2012 seehttp://www.education.gov.uk/childrenandyoungpeople/families/adoption/a00211400/earlier-placement. Concurrent planning is one of the approaches promoted there. As part of this initiative, Coram has been funded to broaden its reach as a national centre of excellence in adoption and early permanence, in support of local authorities.
The Coram project’s partner local authorities have successfully placed children through the project, leading to children being adopted or being returned home. Over the life of the project, 57 children have been fostered in concurrent planning foster placements, of whom three returned to the care of a family member, and 54 have been adopted. Two are in the process of court proceedings.
Coram’s concurrent planning service has been particularly active in terms of evaluation and research, and in taking learning beyond the immediate service context. It was one of three projects which were involved with Elizabeth Monck et al’s 2003 evaluation of this approach; it has hosted research into the impact of contact on infants and Coram will be undertaking a new study of the outcomes of its concurrent planning placements in the next six months. What follows summarises the rationale for the concurrent planning approach and the results of evaluation of it to date.
Where parental difficulties are deep-seated and intractable, separation of parent and child may be necessary. Such decisions need to be made swiftly and lead to prompt and decisive action. Recent national statistics reveal how the chances of adoption diminish as children grow older: 90% of children who were placed for adoption in 2009-10 entered care before the age of four and 61% before their first birthday (Department for Education, 2011). Another body of evidence shows that as children grow older they may benefit less, both from specialist interventions to address the consequences of abuse and from separation to prevent its recurrence (Montgomery et al. 2009; Ward, Holmes and Soper, 2008). Decisions about whether or not to separate children from their birth families will also be influenced by evidence concerning the outcomes of adoption (See Selwyn et al. 2006).
Studies of the long-term outcomes of infant adoptions are necessarily based on children who were placed several decades ago at a time when there were still powerful economic and social pressures on unmarried women to relinquish their children. Adoptions of these children, who are now in late middle age, show favourable psycho-social outcomes and low disruption rates (see Selwyn et al. 2006 for further details). It is unlikely that these children would have experienced abuse before placement. However the majority of children placed for adoption currently in the UK have experienced maltreatment prior to entry to care or accommodation, and many will have experienced lengthy delays, insecurity and instability before permanence decisions are made and adoptive placements found. On average, children are looked after for 2.7 years before the adoption is finalised (Department for Education, 2011), though they reach their permanent placement in a shorter period (Ward et al. 2006).
Given their previous experiences, it is not surprising that some children who are adopted also experience emotional difficulties, depression and confusion over identity (Neil, 2000; Smith and Brodzinsky, 2002). Biehal and colleagues (2010) found that adopted children in England were more likely to experience mental health problems than the wider population. Furthermore, there is an evidence base that highlights that not all adoption placements last (Thoburn, 2005; Selwyn et al. 2006; Farmer et al. 2010). Moreover, research using the self-reported feelings of adopted children suggests that statistics on placement breakdown hide an underlying unhappiness for some children in placements that do persist (Thoburn, 2002). Disruptions are closely associated with emotional and behavioural difficulties, and especially ‘aggressive, acting out behaviours including cruelty to others, getting into fights, threatening others, over activity, restlessness, hanging out with bad friends and overt sexualised behaviour’ (see Selwyn et al. 2006). There are also greater risks of adoption disruption for sibling groups and children with additional needs (Rushton, 2003).
Nevertheless, adoption has generally been associated with lower rates of disruption than long term foster care (see Biehal et al. 2010), and the majority of adoptions last until adulthood. Howe’s (1998) review of outcome studies found that, on a measure that combined disruption rates, developmental rates and adopter satisfaction rates, 50-60% of late adoptions were successful.
There are strong indications that the younger the child is when placed for adoption, the better the chances of both a stable placement and successful psycho-social outcomes. The older children are at placement, the more likely they are to display behavioural problems, including problems with peer relationships, attachment, conduct disorder and poor concentration (Haugaard, Wojslawowicz and Palmer, 1999; Biehal et al. 2010), and therefore the greater the risk of disruption. As with local authority care, it appears that adoption can provide a nurturing environment from which most children will benefit, but the security of an adoptive home cannot always overcome the consequences of extensive maltreatment and neglect.
There is an extensive body of research which shows conclusively that the early environment, and the first three years of life in particular, play a major role in shaping children’s cognitive, social-economic and behavioural development (See Barlow and Underdown, 2008). Therefore, abuse and neglect during this time can be particularly damaging (see Schore, 2003; Gerhardt, 2004). There is also mounting evidence that secure responsive care in the first few months of life leads to better regulated stress reactions (Gunnar and Cheatham, 2003), providing further support for the early removal of infants from parents likely to neglect or abuse them (Monck et al. 2004).
Findings from a prospective longitudinal study on infant suffering, or likely to suffer, significant harm completed by Ward and colleagues show that delays in decision-making culminated in very young children spending lengthy periods experiencing abuse and neglect before entering care. This was followed by long episodes in temporary care where the children would form close bonds with interim carers before experiencing a sense of loss once permanency was achieved. These factors contributed to the fragility of many of the permanent out-of-home placements for the sample children which were further compounded by: severe behavioural difficulties, including aggression and self- harm and carers’ misunderstanding of the likely effects of the child’s past experiences, i.e. they believed that because they were young (under three years) they would be able to ‘forget’ their past and form a positive attachment to their new carers (Ward, Brown and Westlake, 2012).
Concurrent planning in adoption cases aims to improve the welfare and outcomes for highly vulnerable looked after children by reducing delays in initial placement and achieving permanency and in reducing the number of placements children experience. This programme works with a group of children who bring very high levels of risk to resilience due to their pre-birth and early experiences, a group whose difficulties are often intensified by extensive delays to the decisions to permanently separate them from birth families (Ward et al. 2012). The aim of concurrent planning is to maximise their chances of better outcomes through creating the conditions for a secure early attachment to a committed carer. A study conducted by Monck and colleagues (2004) examined the outcomes of concurrent planning compared to traditional adoptions and found that there were substantial advantages for the infants in speeding up the achievement of permanence in the concurrently planned group.
The full details for references quoted in this text can be obtained on request from the C4EO team at the NFER.
Concurrent planning carers are carefully selected and trained to support the child’s parents and relatives during contact, with a view to enabling rehabilitation if possible. They are also approved as adopters as many of these babies are unlikely to be able to return home safely within required timescales. The carers and the child’s parents/ other relatives receive intensive support during and after the fostering period, regardless of outcome.
The project aims, wherever possible, to place the child with foster carers who share his or her cultural background and ethnicity.
The foster carers are asked to:
• ensure at least one carer is at home full-time with the child during the placement
• provide dedicated foster care to one child only (or occasionally two siblings) during the placement
• escort the child themselves to and from contact with the birth parent
• spend time with the birth parent both at the beginning and end of contact sessions, to facilitate smooth transition
• be willing to build a positive and respectful relationship with the baby’s parents
• be prepared to actively support the transfer of the child’s care back to his/her parent(s) or relatives should the court decide it is safe to do so.
Coram facilitates supervised contact between the baby and birth parent(s) as required by the court, until the assessment process is complete and the decision is made about the baby’s future. It submits a report to the court on contact and on the birth parents’ ability to make use of the support offered and their ability to make the necessary changes in their lives. If return to the birth parent(s) is not considered possible by the court, the baby will be adopted by the concurrent planning carers.
In the small number of cases where the child returns to its birth parent(s) or extended family, the concurrent planning carers will work closely with the parent or relative to achieve as smooth a transition as possible.
Steps to achieving concurrent planning placements
1. Recruitment of concurrent planning carers emphasises the child centred focus of the programme. People who approach Coram as prospective adopters are also informed of the possibility of concurrent planning. The Coram website publicises the project, and we use the media to increase public awareness.
Concurrent planning is described to enquirers as a win-win placement for the babies concerned, who will have the opportunity to develop secure attachments with their carers whilst still maintaining close contact with the mother (and/or other relatives). Whether the child returns to the birth family or is adopted by the carer, the child suffers the minimum of disruption to attachments. The adults are the ones who take the emotional risks. As a result, those who apply to be approved as concurrent planning carers are an exceptionally child centred group, who see their task as ensuring that these vulnerable children have the best care and the best opportunity for permanence. They knowingly accept the risk that the child will return to its family, although they are also approved as adopters and motivated to adopt.
Concurrent planning carers also know that these young babies (often placed from hospital) are too young for viral screening, and may develop blood-borne viral illnesses, so they take additional risks in accepting such placements.
2. The carers undertake specific preparation for fostering via concurrent planning in addition to preparation for adoption. This preparation includes learning about the fostering task, working in partnership with the local authority, managing contact and working with the child’s parents.
3. Contact is at the heart of the process and carers are particularly prepared for this and supported to develop a relationship with the child’s birth mother (or relative). Babies often attend contact three or more times per week, meaning that their carers and parent/relative meet frequently. The project ensures that in addition to the dedicated contact supervisor (who is highly skilled and who usually supervises the majority of contacts, providing continuity for the baby and the mother/ relative) at least one social worker is always present, as either the carer or the parent may need support.
• Longer term benefits: In situations where the baby is finally adopted, this contact means that the mother (or relative) has the comfort of knowing who will care for her child. Indeed a small number of mothers have relinquished their baby for adoption voluntarily, seeing how cherished their baby was. Others have commented that if the court’s decision should be that their baby should be adopted, it would be a comfort to know that the adopters are so committed to the baby. In addition, the adopters have a real understanding of their adopted child’s background, which enables them to talk to their child about this in a more rounded way.
• Post-adoption contact: This is also more meaningful since the parties have already developed a relationship. This is so whether contact is arranged via letterbox or face to face meetings.
4. Social work support to all parties is essential throughout the process, given how emotionally stressful it is for the mother (or relative) and also the carers. In a small number of cases, the baby has returned to his mother or other relative. In other cases, this appeared to be the likely outcome for a period during the assessment, although at some point the mother was not able to sustain her apparent progress. In all these cases, the concurrent planning carers faced the very real prospect of losing the baby to whom they had become attached. Where return to birth family is likely, contact becomes more intensive and in the final stages (for those babies who returned home), it takes place in the home of the mother or family member. Where babies have returned to birth families, these situations were of course very stressful for the carers, but their child-centred focus and their wish to make the transition as easy and as smooth for the baby as possible, enabled them to persevere and to cooperate with the rehabilitation programme.
Throughout the process, both the birth family and the carers depend on having reliable and empathetic support from project staff, who operate as a team, with each member of the team able to provide support as necessary. The social work staff and the contact supervisor also need reliable professional supervision to enable the team to deal with the inevitable anxieties and difficulties which occur.
Organisations, stakeholders, practitioners involved in the intervention
Success, for such a specialist project, is dependent on working in partnership with local authorities to secure timely outcomes for children. Coram, as a registered Voluntary Adoption Agency and as a Fostering Agency, is responsible for the approval and support of foster and adoptive carers but not for agreeing who ‘should be placed for adoption’ or for the matching of the children, which remain the statutory responsibility of the local authority. Coram has a good track record of working in partnership with local authorities. Concurrent Planning as an intervention also requires the team to work closely with the Children’s Guardian and the courts.
The service’s key performance measure is in its ability to place children, reported below under ‘Data’; there is also qualitative feedback from service users below under ‘Feedback’. A study of their outcomes is ongoing and we report below some interim findings.
Over the last three years, the Coram Concurrent Planning service has placed 16 children.
2008-2009 – 5 children placed
2009-2010 – 5 children placed
2010-2011 – 6 children placed
There is a steering group for the service which includes local authority partners, representatives from the Family Proceedings Court, and other experts in the field.
Over the life of the project, 57 children have been fostered in concurrent planning foster placements, of whom three returned to the care of a family member, and 54 have been adopted. Two are in the process of court proceedings. A study of this work is just starting.
The difference made
What are the benefits?
For the child:
• consistency and continuity of dedicated foster care from a carer able to form an emotional attachment with the child, focused on the child’s individual needs
• reduced delay in arranging permanent placement , whether via return to the child’s family or via adoption.
• consistency of contact arrangements aimed at minimising disruption to the child’s routines
• expert supervision during contact with the birth parent(s)
• expert support for the foster carers in meeting the baby’s particular needs during placement and up to, and following, adoption.
For the birth parent(s):
• expert support and parenting coaching during supervised contact
• social work support to help them to make the changes necessary for the return of their child
• where this is commissioned, independent, objective, expert assessment of their parenting skills and their ability to change
• pre-adoption counseling, where adoption is the plan
• post-adoption support, where adoption is the outcome.
Good practice in concurrent planning
The key areas to note are:
• proactive recruitment of prospective concurrent carers from diverse black and minority ethnic communities
• adequate financial support during fostering phase to enable lone parents and those on low incomes to undertake this role – Coram has agreed this with local authorities
• settling in time – the courts to allow a settling in period of seven to 14 days with the foster carers before contact begins - this is what we would like, but we are not aware that we have achieved this
• short travel time – the distance between foster placement and contact venue to be no greater than 20 miles
• regularity of contact – ideally not more than three times per week – this is not in our gift, it is what we might prefer
• active supervisor role – the contact supervisor coaches and models good parenting for the birth parent during contact.
Coram’s service was a key participant in Monck et al’s evaluation of concurrent planning.
A summary of this evaluation (from the abstract) is shown below.
‘The primary aim of the evaluation was to assess the effects of using the concurrent planning approach on the children’s care careers. Records were obtained of the number of moves between households and the dates of key events before the child's permanent family placement was confirmed by the courts. The CP children moved into permanent families significantly faster and with significantly fewer previous moves than the two comparison groups. Unexpectedly, the CP children were significantly younger than the children following ‘traditional’ adoption programmes, making direct comparison impossible. Among those birth parents who were interviewed, the majority saw advantages in the CP approach. Concurrent planning carers reported high levels of personal anxiety but positive views of the advantages for the children. The evaluation concluded that CP can be used to achieve earlier permanence and fewer moves between carers for young children from selected birth families. The success of a CP team is dependent on the support of other professionals involved in determining permanent placements, based on a shared acknowledgement of the damaging effects of delay for the looked after child.’
Ongoing study of outcomes for Coram’s concurrent planning children – interim findings
An interim report from Coram on concurrent planning is available at:http://www.coram.org.uk/assets/downloads/Coram_Concurrent_Planning_Interim_Report_final.pdf
59 children were placed through the scheme from 2000-2011. Of the 57 children for whom we have data, all have remained with the Coram Concurrent Planning (CCP) carers with whom they were placed. The children are now aged up to 12. None have experienced post placement disruptions, and none have been returned to care.
Nationally, between 2.5 and 20% of all adoptions, and 1 to 5% of adoptions of children under one year of age, break down. Knowing that, as children get older, both the chances of finding an adoptive placement and of avoiding placement breakdown are part of the rationale for concurrent planning.
Amongst the 59 children placed through the concurrent planning scheme between 2000 and 2011, 36 children (61%) were referred to the project at or before birth. Fifty-six (95%) of these referrals were made prior to a child’s first birthday. Nationally, 61% of those adopted in 2007-2011 were under one year old when starting their final period of care (continuous period of being looked after) (DfE, 2011).
The average age of children adopted by Coram concurrent planning carers was 17 months (2002-2012). Nationally, over the last five years, the average age at adoption is three years and 11 months.
The interim report provides information from administrative records on the timescales from placement to adoption or reunification, and these will be confirmed through detailed file study. Comparisons on timescales can be made for those who went on to be adopted. On average, children placed for concurrent planning took 14 months from entry to care to being adopted. Nationally, over the past five years, time from entry to care to adoption averaged two years and seven months.
Looking at the picture for children who entered care under one year old, the average time for concurrent planning children between entry to care and adoption was also 14 months. In 2011, the national average time between entry to care and adoption for those entering care under one was two years and three months.
Ninety-six percent of children adopted through concurrent planning met the national scorecard target and waited less than 21 months between entering care and moving in with their adoptive family. Nationally, 58% of children waited less than 21 months. This comparison refers to the date to placement order, which averages at about nine months for concurrent planning, but the concurrent planning children were actually living with their carers well before that point.
Feedback from service users
The children placed with the concurrent planning carers are infants and toddlers and cannot be consulted as older children can be, however we set out to place the child at the centre of all that we do. The babies we place are particularly vulnerable. Many are born with neonatal abstinence syndrome, and many of their mothers have not had antenatal care. The babies are often fractious and easily distressed, therefore needing a calm and reassuring environment.
Coram takes its responsibility of providing high quality care to the most vulnerable looked after children seriously and therefore seeks feedback from parents and carers to continuously improve the care provided. In addition Coram as a whole takes ‘what matters most to children’ as a key guiding principle in its work. In 2003, it published the highly innovative resource pack Listening to Young Children, co-published with Open University Press, and it has recently produced a completely revised second edition, launched in January 2011.
Survey of adoptive parents
A survey was undertaken in 2011, collecting the views of adoptive parents or those with children in placement, who had received a service from Coram’s adoption and permanency teams over the last ten years. Fourteen concurrent planning parents responded to this survey. Of these parents, three had adopted two children and the rest one. Two had the child/ren placed 1-2 years ago, six 3-5 years ago, four 6-8 years ago and two 9 or more years ago. Of the 14 respondents, nine were couples and four were single carers/adopters (one respondent did not complete this question).
Comments from adoptive parents, looking back at the service they received as foster carers, were generally positive.
‘There is always someone to turn to for advice and help, staff never make you feel they are too busy for you. There is continuity of staff. The social events mean there is a group of people to meet within similar situations, and that is very special.’
The survey took place in a period when the future of the concurrent planning service was uncertain because of a temporary reduction in referrals. However there has been a resurgence of interest in this method of working, and Coram has committed to continuing the work of this team.
One respondent suggested that aspects of preparatory course could be better ‘i.e. attachment, mental health and nurture/nature’. Another felt that she should have been helped more to understand the needs created by the child’s attachment issues at an earlier stage.
Two respondents raised the need for greater focus on financial issues.
We have made the following changes made as a result of the feedback.
Knowledge about the impact of early experience on children’s attachments and their neurological development has increased over the past decade, and the training material in preparation groups and suggested reading for carers does now focus on this as an issue.
Better financial information:
The service is now taking a more proactive approach. Financial issues are raised with foster carers/adopters at key stages of the assessment process, approval, and post-adoption. Coram also provides carers access to agencies who can provide the expertise in this complex and changing area.
Recruitment of Black and Minority Ethnic (BME) Group Carers
In 2008, Coram commissioned a consultant who previously worked for the British Association for Adoption and Fostering (BAAF) as their Black Issues consultant, to support the service in strengthening our recruitment of BME carers. The consultant undertook a thorough evaluation of our work in this arena via telephone calls to BME enquirers to the project from 2005 to 2008.
The feedback from those who had worked with Coram was generally very positive, however, there were lessons to be learned from those enquirers who had not proceeded. Many of the enquirers were single women who said that the fostering fee being offered was not sufficient for them to be able to give up work for a year to foster a child. The fee was revised, in consultation with partner local authorities, and this should now be more attractive.
Some respondents would have welcomed a follow-up phone call after their initial enquiry. BME enquirers now receive this. Coram will continue to use innovative ways to recruit carers from BME communities.
Helping others to replicate your practice
Sustaining our practice
Coram is currently working with Cambridgeshire to develop a concurrent planning project within that local authority. We are on the steering group of a group of adoption agencies in the East Midlands which is exploring the possibility of developing a concurrent planning scheme for that region. We have provided training to Barnardo’s (North East), as it is planning to develop concurrent planning in the region.
Costs and benefits
Benefits for the children are related to the importance of achieving early permanent placement for this vulnerable population. This provides them with the best opportunity of developing secure attachments from as early as possible, which is known to promote resilience and optimal emotional and cognitive development. Research has demonstrated that most children who are adopted commence their last care episode before the age of 12 months, but are not adopted until the age of 4 years, 2 months. Thus it is reasonable to assume that if they were not placed with concurrent carers, many of these babies might not be adopted for several years, during which time they might experience a number of changes of carer, with attendant damage to their attachments.
The annual average cost of local authority care for a child in foster care is around £25,000, higher in London where this project operates. For some children, several years’ foster care is avoided through concurrent planning; for others perhaps many years of such care. Court costs may also be reduced through the clear processes linked to concurrent planning.
Concurrent planning is provided on a spot purchase model. An information sheet on the fee structure is available on request from the C4EO team at the NFER.
Learning from the experience
We are currently undertaking a study of the outcomes for children placed through the 11 years’ work of the Coram concurrent planning service. This study has the ethical approval it needs to proceed. See above for early findings based on administrative records.
The study is looking at the current well being of these children and the risks they faced when referred to the scheme, through file study and interviews with parents.
Concerns have sometimes been expressed that the concurrent planning process is weighted against the child’s return to the birth parents and towards adoption. However, concurrent planning is explicitly designed to facilitate the child’s return to the birth parents where possible through the intensive parenting support programme it offers and the consistency of foster care and contact arrangements, which reduce distress and maximise the benefits of contact for the baby and birth parent. It is used only with very young children where the probability of the child’s return home is already weighted against the birth family, based on what is known about their history and current circumstances. However, it gives the birth family the best possible chance to demonstrate that they can make the necessary changes required for the return of the child.
Please see above with regards to Cambridgeshire, East Midlands and Barnardo’s North East.
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